Yin X, Du J, Cai SL, Chen XQ. Risk factors for paternal perinatal depression in Chinese advanced maternal age couples: A regression mixture model. World J Psychiatry 2026; 16(1): 112057 [DOI: 10.5498/wjp.v16.i1.112057]
Corresponding Author of This Article
Xing Yin, Department of Clinical Nursing, School of Nursing, Zhaoqing Medical College, No. 12 Fengle Road, Zhaoqing 526020, Guangdong Province, China. yinxing20000@126.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 19, 2026 (publication date) through Dec 31, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Psychiatry
ISSN
2220-3206
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Yin X, Du J, Cai SL, Chen XQ. Risk factors for paternal perinatal depression in Chinese advanced maternal age couples: A regression mixture model. World J Psychiatry 2026; 16(1): 112057 [DOI: 10.5498/wjp.v16.i1.112057]
Author contributions: Yin X conceptualization; Cai SL and Du J methodology; Yin X and Chen XQ investigation; Du J and Chen XQ data curation; Cai SL writing-original draft; Yin X writing-review and editing. All authors have read and agreed to the published version of the manuscript.
Supported by High-level Professional Groups in Gangdong Province, No. GSPZYQ2020101; and Guangdong Province Educational Research Planning Project, No. 2024GXJK742.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Zhaoqing Medical College and First People's Hospital of Zhaoqing.
Informed consent statement: All participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing Yin, Department of Clinical Nursing, School of Nursing, Zhaoqing Medical College, No. 12 Fengle Road, Zhaoqing 526020, Guangdong Province, China. yinxing20000@126.com
Received: August 26, 2025 Revised: September 29, 2025 Accepted: October 24, 2025 Published online: January 19, 2026 Processing time: 126 Days and 17.4 Hours
Abstract
BACKGROUND
Paternal perinatal depression (PPD) is closely associated with maternal mental health challenges, marital strain, and adverse child developmental outcomes. Despite its significant impact, PPD remains under-recognized in family-centered clinical practice. Concurrently, against the backdrop of rising rates of delayed marriage and China’s Maternity Incentive Policy, the proportion of women giving birth at an advanced maternal age is increasing. Nevertheless, research specifically examining PPD among spouses of older mothers remains critically scarce, both in China and globally.
AIM
To investigate PPD and its influencing factors in Chinese advanced maternal age families.
METHODS
This cross-sectional study included 358 participants; it was conducted among fathers of pregnant women of advanced maternal age at five hospitals in the Pearl River Delta region of China from September 2023 to June 2024. Data were collected via a general information questionnaire, the Social Support Rating Scale, and the Edinburgh Postnatal Depression Scale. Latent profile analysis and regression mixture models (RMMs) were adopted to analyze the latent PPD types and factors that influenced PPD.
RESULTS
The incidence of PPD was 16.48%, and three profiles were identified: Low-symptomatic (175 cases, 48.89%), monophasic (140 cases, 39.10%), and high-symptomatic (43 cases, 12.01%). The RMM analysis revealed that first pregnancy, low income (< ¥3000/month), part-time work, and a history of abnormal pregnancy were positively associated with the high-symptomatic type (P < 0.05). Conversely, high subjective support and support utilization were negatively associated with the high-symptomatic type compared with the low-symptomatic type (P < 0.05). Good couple relationships, high objective and subjective support, and high support utilization were negatively associated with monophasic disorder (P < 0.05).
CONCLUSION
PPD incidence is high among Chinese fathers with advanced maternal age partners, and the characteristics of depression are varied. Healthcare practitioners should prioritize individuals with low levels of social support.
Core Tip: This study investigates paternal perinatal depression (PPD) among spouses of advanced maternal age women in China-an under-researched group. Using latent profile analysis in 358 fathers, we identified three distinct PPD profiles: Low-symptomatic (48.89%), monophasic (39.10%), and high-symptomatic (12.01%), with an overall PPD incidence of 16.48%. Crucially, low income (< ¥3000/month), part-time work, and prior abnormal pregnancy uniquely increased high-symptomatic PPD risk. High social support (subjective/objective) and strong couple relationships significantly protected against severe symptoms. These findings reveal nuanced PPD subtypes in high-risk families, urging targeted screening for fathers with limited social support.
Citation: Yin X, Du J, Cai SL, Chen XQ. Risk factors for paternal perinatal depression in Chinese advanced maternal age couples: A regression mixture model. World J Psychiatry 2026; 16(1): 112057
Perinatal depression (PND) is a major depressive episode that occurs during pregnancy or within four weeks after childbirth up to a year[1]. It is characterized by depressed mood, loss of interest in daily activities, sleep problems, weight changes, poor concentration, feelings of worthlessness, guilt, and suicidal thoughts[1]. Numerous studies have reported a high prevalence of maternal PND (14.5%%-28.5%)[2,3] with severe adverse outcomes, and this condition is recognized as a major public health challenge[4]. While maternal PND has been extensively studied, recent evidence suggests that paternal PND (PPD) also has a high prevalence[5] and negatively impacts fathers’ mental health and quality of life[6]. PPD is often linked to maternal PND, exacerbating marital stress[7] and leading to psychosocial and behavioral problems in the offspring[5,6,8]. Despite growing recognition, PPD remains underdiagnosed and poorly addressed in clinical practice[9-11].
The mental health of partners, particularly in families where women delay childbirth, remains underexplored[12]. Research has shown that partners of women with advanced maternal age face unique stressors, including higher risks of obstetric complications[13,14], reduced familial support[15], and increased caregiving responsibilities[16]. As the number of women delaying childbirth increases globally, particularly in China[17], understanding the mental health challenges faced by their partners is crucial.
Furthermore, most studies on PPD have relied on variable-centered approaches (e.g., regression analysis and confirmatory factor analysis)[9]; however, these methods fail to capture the heterogeneity of mental health experiences among fathers[18]. Therefore, person-centered methods such as latent profile analysis (LPA) are needed to better understand the diverse mental health profiles of fathers during the perinatal period[18,19]. Moreover, integrating LPA with a regression mixture model (RMM) can improve analytical rigor by incorporating predictive factors while accounting for classification uncertainty, thereby offering a more accurate and comprehensive understanding of the determinants of PPD[20,21].
Therefore, this study aims to: (1) Identify latent PPD profiles among Chinese fathers with partners of advanced maternal age using LPA; and (2) Examine the factors associated with profile membership using an RMM. The findings will inform the development of targeted interventions for this underserved population.
MATERIALS AND METHODS
Participants
This cross-sectional survey utilized convenience sampling and was conducted from September 2023 to June 2024 in five hospitals in the Pearl River Delta region of China, located in Guangzhou, Foshan, Zhaoqing, Shenzhen, and Zhongshan. The inclusion criteria were as follows: (1) Spouses of women over 35 years old at delivery, with a gestational age of > 28 weeks or within three months of delivery; and (2) Individuals with normal reading comprehension and verbal expression. The exclusion criteria were men with serious physical diseases, such as malignancy or other serious diseases, and those who refused to participate. Figure 1 illustrates the research process.
Figure 1 Research flowchart.
PPD: Paternal perinatal depression.
Procedures and ethics
Data were collected during prenatal obstetric examination visits, hospitalization for delivery, and postnatal follow-up, with the consent and approval of the hospital staff. This study and the procedures used adhered to the tenets of the Declaration of Helsinki and its future amendments. All participants provided their written informed consent. This study was reviewed and approved by the Ethics Committee of Zhaoqing Medical College and First People's Hospital of Zhaoqing.
Measures
General information questionnaire: Participants completed the social and demographic section of a survey under the supervision of trained evaluators. Data on their age, parity, level of education, family income per capita, living conditions, multiple pregnancies, work status, marital relationship, in-law relationship, and history of abnormal pregnancy were obtained.
Social Support Rating Scale: The Social Support Rating Scale (SSRS), developed by Xiao in 1994, was used to assess participants’ social support status[22]. It comprised 10 items that measured three components: Objective support (three items), subjective support (four items), and support utilization (three items). Different items were scored differently. Items 1-4 and 8-10 were assessed via a 4-point Likert scale. Item 5 was subdivided into four distinct dimensions, namely A, B, C, D, and E, and each dimension was evaluated from 1 to 4 points. Items 6 and 7, if without any source is selected, the score is 0, if with the following sources is selected, the total number of sources is the score of the item. The total score ranged from 12 to 66 points. The higher the score, the greater the social support available to the participant[22]. This scale is widely used in China[23,24] and has good reliability and validity within the male and paternal demographic[23-25].
Edinburgh Postnatal Depression Scale: The Edinburgh Postnatal Depression Scale (EPDS), compiled by Cox in 1987, comprises 10 items. Each item corresponds to 4 options scored from 0 to 3, and the total score ranges from 0-30 points[26]. The higher the score, the greater the severity of depression. The Chinese version was compiled at the Chinese University of Hong Kong and introduced by Lee et al[27] in 1998. Its appropriateness for the spouses of pregnant/postpartum women, as well as its reliability and validity, have been established[28]. This instrument was initially widely used in surveys on maternal PND. We used a cut-off score of 13 to identify participants with elevated symptom levels[29]. This threshold exhibited a sensitivity of 0.66 (95%CI: 0.58-0.74) and specificity of 0.95 (0.92-0.96)[30].
Statistical analysis
Data were aggregated and analyzed via SPSS version 26.0 and Mplus version 8.3. The SPSS software (version 26.0) was used for data analysis. Continuous and categorical data were reported as mean ± SD and count (percentage), respectively. The 10-dimensional scores of the EPDS were used as observational variables for the LPA using Mplus 8.3 with 1-4 categories. The model fit was assessed via various metrics, such as the Akaike information criterion (AIC), Bayesian information criterion (BIC), and corrected BIC (aBIC), with a smaller value model fit[18]. Entropy was used to evaluate the accuracy of categorization, and a value of ≥ 0.8 indicated a categorization accuracy of > 90%[31]. The Lo-Mendell-Rubin likelihood ratio test (LMR) and bootstrap likelihood ratio test (BLRT) were performed, and a P value of P < 0.05 indicated that the k-class model fit better than the K-1 class model[31]. Finally, once the number of k profiles was identified, RMM was used to assess the mutually adjusted associations of general information and social support status with latent class membership. RMM was performed using Mplus 8.3 with a 3-step robust method. A P value of P < 0.05 was considered statistically significant.
RESULTS
Participant characteristics
This study included 358 participants, with a mean age of 37.10 ± 2.75 years. Most participants had finished college (55.87%), had a monthly income of ¥3000-5000 (55.03%), lived in good condition (65.08%), and worked full-time (58.38%). Approximately 32.12% reported a history of abnormal pregnancy in their spouses. The mean EPDS score was 8.97 ± 4.62, and 16.48% reported they experienced PPD (Table 1).
Table 1 General characteristics of the participants (n = 358).
Two methods were used to assess the common method bias. First, Harman’s single-factor test was conducted for evaluation. The results revealed that three factors had eigenvalues > 1, and the first factor explained 35.37% of the variance, which was less than the critical threshold of 40%[32]. Additionally, the latent factor effects control method was used for evaluation. The results revealed that model fit indices only slightly improved with the introduction of the common method factor in the 2-factor model; the comparative fit index and Tucker-Lewis index increased by only 0.01, which was less than the critical threshold of 0.1[33]. This indicated no serious common method bias.
LPA of PPD
PPD patterns were identified via LPA with categories 1-4. Starting from the initial model, and gradually increasing the number of latent classifications until the fit indices of the model no longer improved, four latent profile models were fitted. An increase in the number of classifications decreased the AIC, BIC, and aBIC values, and all entropy values exceeded 0.90. The LMR > 0.05 for the 4-class model suggested that it was not superior to the 3-class model. Conversely, the LMR and BLRT indices indicated that the 3-class model was statistically and clinically meaningful. Considering all these factors, the 3-class model was deemed the optimal classification model for identifying PPD. Table 2 presents the details.
Table 2 Model fit results from the latent profile analysis.
A discriminant analysis was performed to confirm the precision of the optimal LPA model. Posterior probabilities of the three classes were 0.979, 0.986, and 0.960, respectively. All values were > 0.950, suggesting that the outcomes of the optimal model derived from the LPA were trustworthy.
Names of latent profiles in a retained model
Figure 2 illustrates the estimated average plots for the 3-class LPA solution of the dataset. Examination of the trends in the average scores across the 10 EPDS dimensions led to the classification of three subgroups: (1) The “low-symptomatic” group: Individuals who had consistently low scores across all items, which indicated a minimal expression of symptoms; (2) The “monophasic” group: This group exhibited low scores on items 3 and 4 on self-blame and feelings of incompetence and medium-level scores on other items; and (3) The “high-symptomatic” group: Members had elevated scores on various items related to panic, depression, sleep disturbances, and sadness, which were indicative of symptoms associated with a high-symptomatic group.
Figure 2 Latent profile class of paternal perinatal depression.
RMM of depression types in PPD
An RMM that incorporated predictive variables and used “low-symptomatic”, “monophasic”, and “high-symptomatic” as outcome variables, with “low-symptomatic” as the reference group, was constructed using SSRS 3 dimensions scores and general information as independent variables.
The results revealed that good couple relationships, high objective support, high subjective support, and high support utilization were negatively associated with the monophasic disorder group compared with the low-symptomatic group (P < 0.05). First pregnancy, per capita monthly income < 3000, part-time work, and history of abnormal pregnancy were positively associated with the high-symptomatic group (P < 0.05). Conversely, high subjective support and support utilization were negatively associated with the high-symptomatic group (P < 0.05) (Table 3).
Table 3 Regression mixture model of the latent paternal perinatal depression subtype.
This study employed LPA and RMM to investigate the subtypes of PPD and provide appropriate support for fathers during this critical period. The key findings were that the prevalence of PPD among families where the woman was older was 16.48%, which was higher than the depression levels of spouses of primiparous women and women in general. Furthermore, based on a person-centered approach, three latent PPD subtypes were identified, namely “low-symptomatic”, “monophasic disorder”, and “high-symptomatic”. The demographic and perinatal characteristics associated with PPD subtypes differed; higher levels of objective and subjective support and support utilization were associated with the low-symptomatic subtype. Poor marital relationships were associated with the monophasic disorder subtype. In addition, those with a first pregnancy, history of abnormal pregnancy, part-time work, and low income (< ¥3000/month) were more likely to be classified as the high-symptomatic subtype.
The observed PPD prevalence of 16.48% is consistent with rates reported in Saudi Arabia (16.7%), Nigeria (17.8%), and Chile (18.5%)[34-36], indicating that PPD is a pervasive concern that impacts fathers across diverse cultural and socioeconomic landscapes.
However, our rates were lower than those reported in studies from Ethiopia (20.86%), India (24.06%), and Uganda (28%)[28,37], likely due to methodological differences, varying cultural perceptions of mental health, and disparities in healthcare infrastructure and support service accessibility. Conversely, higher rates relative to those in Ireland, Australia, and the United States (7%-12%)[38-40] may reflect socioeconomic barriers, stigma associated with mental health, and less developed support systems that exacerbate psychological distress among Chinese fathers.
Based on a person-centered approach, three latent PPD subtypes were identified: “low-symptomatic”, “monophasic disorder”, and “high-symptomatic”. Particularly, the monophasic disorder subtype scored high on self-criticism and feelings of incompetence (item 4: I feel anxious and worried for no reason), consistent with previous studies that revealed that fathers with depression exhibited excessive self-criticism and anxiety[5]. Their depression symptoms were somewhat one-sided, which made them a group easily overlooked in clinical practice; this suggests that clinical practitioners should pay timely attention to these individuals to prevent the accumulation and outbursts of negative emotions that exacerbate depressive symptoms.
Regarding mood disorders, the scores of the high-symptomatic group were significantly higher than those of the other types in several items, such as low mood (Item 1: I can see the funny side of things and laugh), panic (Item 5: I feel scared and panicky for no very good reason), somatic symptoms (Item 7: I am quite unhappy or downhearted and blue), and self-harm risks (Item 10: I have self-harming thoughts). These scores are consistent with the features of PPD. Thus, clinical professionals should comprehensively and accurately assess a patient’s depressive features and focus on subtle negative symptoms to promptly detect depression and better select and implement early interventions.
Since PPD symptoms are highly heterogeneous, demographic and perinatal characteristics are somewhat specific in their prediction of subtypes.
High social support emerged as a significant factor associated with PPD; fathers with strong social support were less likely to experience PPD than those who lacked sufficient support (OR = 0.708-0.912, P < 0.05). This finding aligns with those of systematic reviews on PPD conducted in the United States and Ethiopia, which emphasized the critical role of social support in safeguarding paternal mental health[28,41]. These results can be understood through the lens of social support theory, which proposes that access to emotional, informational, and instrumental resources enhances an individual’s ability to cope with stress, thereby reducing the risk of depression[42]. This is particularly relevant for partners of advanced maternal age women, who often face heightened psychological strain and adaptive challenges during the perinatal period[43]. Notably, as illustrated in Table 3, subjective support (e.g., perceived emotional availability) demonstrated a stronger and more consistent protective effect across PPD profiles than objective support (tangible assistance), with significant odds ratios ranging from 0.887 to 0.912. In contrast, objective support did not differ significantly between the low-symptomatic and high-symptomatic groups, reinforcing the theoretical notion that an individual’s perception of support is more critical to mental health than its external provision[42]. Emotional support can provide reassurance, and knowledge of help available from others can make various forms of objective support easier to notice and accept, which can enhance support utilization and help individuals through this special period.
Marital relationships had a significant impact on PPD; fathers with good marital relationships were less likely to have monopolar disorder (OR = 0.270, 95%CI: 0.080-0.919). Several studies in Asia and Oceania revealed that low levels of marital relationships were strongly associated with PPD[36,44]. This suggests that spousal support is a vital component of social support[45]. Poor marital satisfaction reduces social support from one’s spouse, which can adversely affect fathers’ mental health, as their primary source of social support is often their partner[44]. The deterioration of marital relationships and social support systems may negatively affect fathers’ perinatal mental well-being.
A history of abnormal pregnancy was identified as a significant predictor of paternal postpartum depression; fathers who had experienced abnormal pregnancy events were twice as likely to develop depression as those who did not (OR = 2.756, 95%CI: 1.156-6.569). These results are consistent with those of studies conducted in Australia, which indicated that a history of abnormal pregnancies increased the risk of depression in fathers[46]. An adverse pregnancy history represents a significant stressor in the lives of women and their partners[47]. As a traumatic event, a history of an abnormal pregnancy is often repressed by conscious awareness residing in the subconscious[48]. However, it persistently manifests in the cognitive processes of trauma survivors and adversely affects their mental well-being; in addition, they may cause anxiety in both the couple and infant in later pregnancies[43,49]. Hence, we must focus on fathers who have experienced adverse perinatal events and provide adequate psychological support to mitigate the likelihood of PPD.
Similarly, fathers whose partners are in the first pregnancies are more likely to be classified as high-symptomatic subtype (OR = 4.451, 95%CI: 1.193-16.61), a finding similar to that of a scoping review[6]; however, this was in contrast to an earlier study[50]. Another study revealed no statistically significant association between the number of babies and PPD[10]. This might be due to differences in participant characteristics or scales employed; however, it also suggested that the impact of the number of children on PPD was fairly complex. Our participants comprised partners of expectant mothers of advanced maternal age who encountered two primary challenges. First, fathers are required to allocate additional time and resources to support older mothers, as their postpartum recovery duration is generally longer than that of younger mothers. Second, the parenting journey can be particularly daunting for first-time fathers, who may lack the necessary skills and experience in child rearing[51]. Baby-crying may disturb everyday routines, cause sleep issues for mothers, and induce symptoms of depression[52].
Furthermore, low family income played a significant role in the variation in PPD. Fathers from low-income households were four times more likely to belong to the high-symptomatic group compared to those from higher-income families (OR = 4.000, 95%CI: 1.182-13.541). This finding aligns with that of a systematic review on PPD conducted in Ethiopia, which emphasized the critical role of family income in safeguarding paternal mental health[28]. Men are often expected to be the “family breadwinner” who is economically responsible for the family, especially given the unpredictable working hours and income of perinatal women. Disparity between limited household income and substantially increased financial obligations that arise after childbirth can result in intensified psychological strain and heightened susceptibility to depression among fathers[53].
Finally, poor employment status was associated with PND in fathers (OR = 2.263, 95%CI: 1.041-4.920), consistent with previous results[6,9]. Generally, fathers are the main providers of income. Part-time employment, which frequently entails lower income or constrained financial resources, is at odds with a significant increase in family expenses accompanying childbirth. This financial pressure can intensify fathers’ sense of guilt and subsequently elevate their psychological stress and risk of depression[54].
Limitations
Our study has several limitations. First, we only investigated fathers, and relevant feedback from pregnant and postpartum women was not included, limiting the ability to analyze interactions between spouses. Second, we only assessed individuals who were willing to participate in the study, potentially leading to underrepresentation of severely affected fathers and underestimation of PPD prevalence. Third, the research data were collected through self-administered questionnaires, which may introduce recall bias.
CONCLUSION
This study investigated PPD and its determinants within Chinese advanced maternal age families. The results revealed a high prevalence of PPD among fathers, alongside distinct depressive symptom profiles, advancing our understanding of paternal mental health in this specific family context. Crucially, depressive symptom subtypes were significantly influenced by social support, per capita family income, and paternal work status. These findings provide an empirical foundation for developing tailored interventions targeting this vulnerable population.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Cho JA, PhD, South Korea; Hoprekstad GE, MD, Germany S-Editor: Qu XL L-Editor: A P-Editor: Yu HG
Gong Y, Feng X, Chan MH, Slesnick N. Prospective Associations of Maternal Depressive Symptoms and Emotion Dysregulation with Children's Internalizing Problems: The Moderating Role of Fathers.Res Sq. 2024;rs.3.rs-4209113.
[RCA] [PubMed] [DOI] [Full Text][Reference Citation Analysis (0)]
Shao M, Yao L, Zhang M, Zhou H, Ding Y, Bai L, Ma B, Li T, Guo S, Chen C, Wang T. Post-surgery financial toxicity and its influencing factors in colorectal cancer care: A cross-sectional study.Eur J Oncol Nurs. 2024;68:102518.
[RCA] [PubMed] [DOI] [Full Text][Reference Citation Analysis (0)]
Fernandes-Pires JA, Pedroso-Chaparro MDS, Jiménez-Gonzalo L, Márquez-González M, Cabrera I, Losada-Baltar A. Marital Satisfaction and Mental Health in Adults Over 40 Years Old. Associations with Self-Perceptions of Aging and Stress Related to the COVID-19 Pandemic.Span J Psychol. 2023;26:e14.
[RCA] [PubMed] [DOI] [Full Text][Cited by in RCA: 4][Reference Citation Analysis (0)]
